Publications by authors named "Nicola X West"

41 Publications

A randomised controlled trial to compare the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste with a control toothpaste for the prevention of dentine hypersensitivity.

J Dent 2021 May 26;108:103619. Epub 2021 Feb 26.

Clinical Trials Group, School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK. Electronic address:

Objectives: To determine the efficacy of a cosmetic aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for the reduction of dentine hypersensitivity (DH) pain as compared to a control toothpaste containing potassium nitrate.

Methods: The study was a randomised, examiner-blind, two treatment arm, parallel controlled trial in healthy adults with at least 2 sensitive teeth (Schiff >2). At baseline, immediately after treatment and at 7 and 14 days of twice-daily brushing of the test or control toothpaste the sensitivity of 2 test teeth was measured following iced-water (Schiff and VAS) and tactile (Yeaple probe) stimuli, and a whole mouth plaque score was obtained. Participants also completed a whole-mouth VAS and DHEQ15 quality of life questionnaire at baseline, 7 and 14 days.

Results: Both toothpastes reduced DH in test teeth, but pain reduction in the test group was significantly better at all timepoints and by all measures (p = 0.005, tooth-level VAS immediately after brushing; p < 0.001 all other comparisons). There was a relative risk reduction of Schiff sensitivity of 55 % immediately after brushing which rose to 81 % after 7 and 88.6 % after 14 days (all p < 0.001). There were no differences in plaque, whole mouth VAS or DHEQ15 scores at any time point.

Conclusion: This study demonstrated the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste compared to a potassium nitrate control toothpaste for the prevention of dentine hypersensitivity both immediately and over a 2 week period. This agent appears to have potential for pain alleviation from the common oral pain condition of DH and further research is warranted.

Clinical Significance: DH pain, whilst transient in nature, is arresting in magnitude, affecting quality of life. Daily application of efficacious toothpastes can relieve DH pain however, as yet, there is no gold standard treatment. The results of this study support further investigation of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for DH management.
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http://dx.doi.org/10.1016/j.jdent.2021.103619DOI Listing
May 2021

Randomised controlled trial of a microneedle patch with a topical anaesthetic for relieving the pain of dental injections.

J Dent 2021 04 23;107:103617. Epub 2021 Feb 23.

Clinical Trials Unit, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, United Kingdom. Electronic address:

Objectives: To determine whether a microneedle patch combined with 5% topical lidocaine reduces dental injection pain more than a patch without microneedles combined with 5% topical lidocaine.

Methods: This proof of principle randomised, two-treatment, double-blind, crossover split-unit design study in 16 healthy participants investigated levels of perceived pain from 3 increasing pain provoking challenges, when topical 5% lidocaine dental gel was applied to the oral mucosa with a microneedle patch and a patch with no microneedles, prior to infiltration with local anaesthesia on 2 visits. Pain was assessed by visual analogue scale (VAS) and 4-point verbal rating scale (VRS).

Results: 15 participants completed the study. Mean pain scores, lower at buccal sites, increased in both groups across challenges 1-3: Test palatal 5.1, 11.9, 26.8; buccal 0.7, 2.8, 18.3; Control palatal 12.3, 18.7, 39.5; buccal 4.0, 6.9, 30.6. The microneedle patch plus lidocaine significantly lowered VAS pain scores at both sites for all challenges, the biggest mean difference seen palatally after challenge 3 (12.7, p < 0.001). VRS pain scores were also significantly reduced for test compared to control for all 3 challenges (p = 0.014). Buccal scores favoured the microneedle patch, significantly for pain challenge 3 (p = 0.025). No adverse events occurred.

Conclusions: Prior oral application of a microneedle patch combined with 5% topical lidocaine gel reduced the pain experienced from dental infiltration. Microneedle patch use in the dental setting offers the prospect of improving degree and depth of anaesthesia from topically applied anaesthetic gel, without itself causing any pain.

Clinical Significance: Dental injections are associated with fear and anxiety. Application of a microneedle patch, combined with topical anaesthetic, to the oral mucosa prior to delivery of the injection reduces the pain from this dental procedure. This novel technique may allay patients' apprehension of local anaesthesia and improve quality of life outcomes.
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http://dx.doi.org/10.1016/j.jdent.2021.103617DOI Listing
April 2021

Comparison of Blood Bacterial Communities in Periodontal Health and Periodontal Disease.

Front Cell Infect Microbiol 2020 5;10:577485. Epub 2021 Jan 5.

Periodontology, Bristol Dental School, University of Bristol, Bristol, United Kingdom.

The use of Next Generation Sequencing (NGS) techniques has generated a wide variety of blood microbiome data. Due to the large variation in bacterial DNA profiles between studies and the likely high concentrations of cell-free bacterial DNA in the blood, it is still not clear how such microbiome data relates to viable microbiota. For these reasons much remains to be understood about the true nature of any possible healthy blood microbiota and of bacteraemic events associated with disease. The gut, reproductive tracts, skin, and oral cavity are all likely sources of blood-borne bacteria. Oral bacteria, especially those associated with periodontal diseases, are also commonly associated with cardiovascular diseases such as infective endocarditis, and also have been linked to rheumatoid arthritis and Alzheimer's disease. Periodontal treatment, dental probing, and toothbrushing have been shown to cause transient bacteraemia and oral bacteria from the phyla Firmicutes (e.g. ) and Bacteroidetes (e.g. ) are found in cardiovascular lesions (CVD). Many studies of blood bacterial DNA content however, find Proteobacteria DNA to be the dominant microbiome component, suggesting a gut origin. Most studies of this type use total DNA extracted from either whole blood or blood fractions, such as buffy coat. Here, using a method that purifies DNA from intact bacterial cells only, we examined blood donated by those with active, severe periodontitis and periodontally healthy controls and show that 43-52% of bacterial species in blood are classified as oral. Firmicutes, consisting largely of members of the group and , were predominant at 63.5% of all bacterial sequences detected in periodontal health and, little changed at 66.7% in periodontitis. Compared to studies using total DNA Proteobacteria were found here at relatively low levels in blood at 13.3% in periodontitis and 17.6% in health. This study reveals significant phylogenetic differences in blood bacterial population profiles when comparing periodontal health to periodontal disease cohorts.
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http://dx.doi.org/10.3389/fcimb.2020.577485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813997PMC
January 2021

Bioavailable gluconate chelated stannous fluoride toothpaste meta-analyses: Effects on dentine hypersensitivity and enamel erosion.

J Dent 2021 02 28;105:103566. Epub 2020 Dec 28.

Periodontology, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK. Electronic address:

Objectives: To compare the effect of bioavailable gluconate-chelated stannous fluoride (SnF) toothpaste with control toothpastes for treatment of dentine hypersensitivity (DH) and enamel erosion.

Data And Sources: A Procter & Gamble Oral Care archive of clinical studies was reviewed from 2000 to 2020. Eligible studies were Randomised Controlled Trials (RCTs) investigating bioavailable gluconate-chelated SnF toothpaste efficacy compared to controls in adult participants measured following tactile (Yeaple force) and/or evaporative stimuli (Schiff score) in-vivo, duration <2 months (DH); or by erosive toothwear (profilometry) from in-situ samples, duration 10-15 days. Two authors independently assessed eligibility and resolved disagreements by discussion. A meta-analysis was undertaken and Risk of Bias (RoB) assessed using the Cochrane collaboration RoB tool for randomized parallel-group and cross-over trials.

Results: Fourteen RCTs (1287 participants) assessed DH relief and Six RCTs (184 participants) enamel erosion protection. For DH SnF toothpastes provided a 57 % (evaporative air) and 142 % (tactile) benefit versus negative controls (sodium fluoride/monofluorophosphate, 8 studies; p < 0.001). Compared to positive controls (potassium nitrate or arginine, 6 studies), a 22 % advantage (p = 0.036) was seen for evaporative air. In erosion studies, SnF toothpastes provided an 83 % benefit versus control toothpastes (arginine or sodium fluoride; p < 0.001) with a change (95 %CI) in average surface profilometry level (μm) of -2.02(-2.85, -1.20).

Conclusions: The use of these bioavailable SnF toothpastes, as part of a daily oral hygiene regimen, will provide patients with enamel erosion protection, combined with alleviation of DH pain when present, improving quality of life.
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http://dx.doi.org/10.1016/j.jdent.2020.103566DOI Listing
February 2021

The ability of a potassium oxalate gel strip to occlude human dentine tubules; a Novel in vitro: In situ Study.

J Dent 2020 09 28;100:103437. Epub 2020 Jul 28.

Clinical Trials Unit, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, United Kingdom. Electronic address:

Objectives: To determine if an oxalate strip reduced fluid flow in dentine samples and whether this reduction was maintained following a 14 day intra-oral period.

Methods: Dentine tubule fluid flow was measured by a modified Pashley cell in 40 acid-etched dentine discs 1 mm thick, diameter >10 mm, with an acquired pellicle, pre-equilibrated with Hartmann's solution and conditioned by toothbrushing, pre and post treatment (10 min) with an oxalate (3.14 %) gel strip or no treatment. One control and one test sample were exposed in-situ for 14 days to the oral environment in 20 healthy adult volunteers, and fluid flow re-measured. The appliance containing the two samples was removed for brushing with water after mealtimes when the participant brushed their teeth and for a 2 min daily soak in chlorhexidine.

Results: Fluid flow rate was reduced significantly immediately following treatment with the oxalate strip compared to baseline flow rate by 58 %. Following 14 days in-situ oral environment phase, a significant further reduction in fluid flow compared to baseline was identified in both control and oxalate strip treated samples, both (p < 0.0001), but the reduction was greater in the test samples, 94 % vs 87 %, p < 0.01.

Conclusions: This novel investigation is the first to show fluid flow measurement using the Pashley model in dentine samples that have been housed in the mouth for 14 days. Treatment with an oxalate strip designed for dentine hypersensitivity alleviation reduced dentine fluid flow more than control providing evidence that the oxalate treatment withstood the oral environment over a prolonged time.

Clinical Significance: This study demonstrated the efficacy and durability of the oxalate precipitate over a 14 day period in achieving and maintaining dentine tubule occlusion when participants had no dietary restrictions. This demonstrates the suitability of the oxalate strip for the treatment of patients suffering from dentine hypersensitivity pain.
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http://dx.doi.org/10.1016/j.jdent.2020.103437DOI Listing
September 2020

A novel cervical tooth wear and recession index, the cervical localisation code, and its application in the prevention and management of dentine hypersensitivity.

J Dent 2020 09 16;100:103432. Epub 2020 Jul 16.

Clinical Trials Unit, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY United Kingdom. Electronic address:

Objectives: To design and validate a new index to assess tooth wear (TW) in the cervical region and its association with gingival recession (GR), for use both in research studies and as resource in General Dental Practice, with focused prevention and management strategiesparticularly related to aetiology of dentine hypersensitivity provided for each Code score.

Methods: Codes to reflect clinical presentations of the cervical region in health and disease recording both TW and GR were defined. Validation of the Code was undertaken by 3 trained examiners who scored buccal and lingual surfaces of eligible teeth in 42 adult healthy volunteers. Each volunteer underwent 4 identical clinical examinations, being assessed twice by the examiner who performed the first and last exam.

Results: Cervical Localisation Code definitions were A: no GR, no coronal TW, B: no GR, distinct coronal TW, C: GR but no coronal TW, D: GR with distinct coronal and root TW. For validation 2073 eligible tooth surfaces were scored. There were only 57 within and 201 between examiner disagreements, the most common being between scores C and D.

Conclusions: The Cervical Localisation Code was used reproducibly by three independent examiners. It will provide focussed data on the cervical region in research studies allowing the association of patient reported dietary and lifestyle factors with specific lesion types, and a tool to aid the management of clinical scenarios, specifically those that lead to dentine hypersensitivity in general dental practice.

Clinical Significance: Exposure of dentine at the cervical margin by TW and/or GR often results in dentine hypersensitivity, however current TW indices do not record TW location or GR presence. The Cervical Localisation Code captures both parameters and suggests likely aetiology for dentine hypersensitivity and guide clinical management of the cervical region.
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http://dx.doi.org/10.1016/j.jdent.2020.103432DOI Listing
September 2020

A randomised controlled trial investigating efficacy of a novel toothpaste containing calcium silicate and sodium phosphate in dentine hypersensitivity pain reduction compared to a fluoride control toothpaste.

J Dent 2020 07 1;98:103320. Epub 2020 Jun 1.

Clinical Trials Group, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK. Electronic address:

Objectives: To compare a calcium silicate and sodium phosphate toothpaste (CSSP) with a fluoride negative control toothpaste for dentine hypersensitivity (DH) pain reduction after 14, 28 and 29 days.

Methods: This was a double blind, parallel study in 247 healthy adults with DH (Schiff score >2, tactile 10-20 g) in 2 teeth in different quadrants of the mouth. After acclimatisation, participants were randomised to CSSP or control toothpaste. After measuring baseline sensitivity products were applied twice-daily by toothbrushing, and once daily massaging into the sensitive teeth. Sensitivity was assessed following airblast (Schiff and VAS) and tactile (Yeaple probe) stimuli at baseline, 14 and 28 days, and at 29 days, 12 h after last product application. Participants completed a quality of life questionnaire at each study visit up to day 28.

Results: After 14, 28 and 29 days the CSSP group had significantly lower Schiff, lower VAS and higher Yeaple probe scores compared to control (VAS at 14 days, p < 0.04; all other comparisons, p < 0.001). Quality of life scores improved in both groups, but no significant differences between groups were observed.

Conclusions: The CSSP toothpaste was more effective than the fluoride control toothpaste at reducing DH pain with benefit persisting 12 h following application.

Clinical Significance: This novel calcium silicate and sodium phosphate toothpaste (CSSP) toothpaste is an effective twice-daily treatment when brushed on the teeth for dentine hypersensitivity sufferers compared to brushing with a conventional fluoride paste. Twice-daily brushing provides a sustained effect for long-lasting pain relief from dentine hypersensitivity.
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http://dx.doi.org/10.1016/j.jdent.2020.103320DOI Listing
July 2020

A randomised controlled trial to determine patient experience of a magnetostrictive stack scaler as compared to a piezoelectric scaler, in supportive periodontal therapy.

J Dent 2020 02 10;93:103279. Epub 2020 Jan 10.

Periodontology, Clinical Trials Group, Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK. Electronic address:

Objectives: To compare the pain/discomfort experienced by patients in supportive periodontal therapy, following treatment with a piezoelectric ultrasonic scaler, designed for use with warmed water irrigation, and a magnetostrictive ultrasonic scaler.

Methods: This was a single-centre, randomised, split mouth study with regard to side, and crossover with regard to treatment order. Patients attending general dental practice for supportive periodontal therapy were randomised to receive treatment from one scaler on the left and the other scaler on the right-hand side of the mouth, the left side of the mouth always being treated first. The piezo scaler (Tigon+®) was used with room temperature irrigation for half of the participants (approx 20 °C) and warmed water irrigation (approx 36 °C) for the other half. The magnetostrictive scaler (Cavitron Select SPS 30K®) was used with room temperature irrigation (approx 20 °C) only. Participants rated their pain/discomfort, noise and vibration by VAS scale.

Results: 140 participants completed the study. Mean VAS scores for all measures were significantly better for the piezo scaler used with warm irrigation as compared to the magnetostrictive scaler p < 0.001. When both scalers were used with room temperature irrigant, there were no significant differences in the VAS scores between scalers (pain/discomfort, p = 0.68; noise p = 0.2; vibration p = 0.85).

Conclusions: Participants indicated to statistical significance, less pain/discomfort, noise and vibration when the piezo scaler (Tigon+®) device was used with warmed irrigant, compared to the magnetostrictive scaler (Cavitron Select SPS 30K®). There were no significant differences between the instruments when room temperature irrigant was used.

Clinical Significance: Regular scaling in supportive periodontal therapy, is essential for maintenance of susceptible patients, however it can be painful due to dentine hypersensitivity deterring patients from attending. Using a piezo scaler with warm water improves patient quality of life and subsequent oral health. This may have positive effects on patient attendance.

Isrctn Registered: ISRCTN15573995.
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http://dx.doi.org/10.1016/j.jdent.2020.103279DOI Listing
February 2020

Terminology of Erosive Tooth Wear: Consensus Report of a Workshop Organized by the ORCA and the Cariology Research Group of the IADR.

Caries Res 2020 14;54(1):2-6. Epub 2019 Oct 14.

Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, Indiana, USA.

Our understanding of erosive tooth wear and its contributing factors has evolved considerably over the last decades. New terms have been continuously introduced, which frequently describe the same aspects of this condition, whereas other terms are being used inappropriately. This has led to unnecessary confusion and miscommunication between patients, professionals, and researchers. A group of 15 experts, selected by the European Organization for Caries Research (ORCA) and the Cariology Research Group of the International Association for Dental Research (IADR), participated in a 2-day workshop to define the most commonly used terms in erosive tooth wear. A modified Delphi method was utilized to reach consensus. At least 80% agreement was achieved for all terms discussed and their definitions related to clinical conditions and processes, basic concepts, diagnosis, risk, and prevention and management of erosive tooth wear. Use of the terms agreed on will provide a better understanding of erosive tooth wear and intends to enable improved communication on this topic.
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http://dx.doi.org/10.1159/000503308DOI Listing
November 2020

Dementia friendly dentistry for the periodontal patient. Part 2: ethical treatment planning and management.

Br Dent J 2019 Oct;227(7):570-576

Clinical Trials Unit, Bristol Dental Hospital & School, University of Bristol, 4th Floor Chapter House, Lower Maudlin Street, Bristol, BS1 2LY, UK.

This is the second of two articles, which provide a guide to aid the clinical management of people living with dementia who present with periodontitis in dental practice. Guidance is provided to encourage optimal treatment planning and periodontal care for patients with dementia. Best practice in relation to UK statutory legislation, which governs the rights of those with impaired capacity, is also covered. Although the articles centre on periodontal care, much of the content is equally applicable to the wider general dental care for the dementia patient.
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http://dx.doi.org/10.1038/s41415-019-0728-2DOI Listing
October 2019

Dementia friendly dentistry for the periodontal patient. Part 1: recognising and assessing patients with dementia.

Br Dent J 2019 Oct;227(7):563-569

Clinical Trials Unit, Bristol Dental Hospital & School, University of Bristol, 4th Floor Chapter House, Lower Maudlin Street, Bristol, BS1 2LY, UK.

This is the first of two articles that provide a guide for the clinical management for people with dementia who present with periodontal disease in dental practice. Conditions that cause dementia and their increasing prevalence are described. Advice is given to aid the dental team in recognising patients with dementia. The impact that dementia and the medications used in its medical management have on the oral environment are also covered. The complexities of completing an accurate periodontal assessment for those with dementia are discussed and indications for best practice provided. Although both articles (Part 1 and Part 2) centre on periodontal care, much of the content is equally applicable to wider general dental care for the dementia patient.
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http://dx.doi.org/10.1038/s41415-019-0726-4DOI Listing
October 2019

Living with periodontitis.

Authors:
Nicola X West

Br Dent J 2019 10;227(7):537

Guest Editor of the Periodontics Themed Issue, Periodontology, Bristol Dental School, UK.

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http://dx.doi.org/10.1038/s41415-019-0838-xDOI Listing
October 2019

The erosion protection efficacy of a stabilized stannous fluoride dentifrice: An in situ randomized clinical trial.

Am J Dent 2019 Jun;32(3):138-142

The Procter & Gamble Company, Mason, OH, USA.

Purpose: To compare the enamel protection efficacy of a stabilized stannous fluoride dentifrice to a triclosan-containing sodium fluoride dentifrice using a 10-day in situ erosion model, in accordance with the American Dental Association Seal of Acceptance guidelines for enamel erosion control.

Methods: In this single-center, double-blind, randomized, supervised-usage, two-treatment, four-period, crossover study, healthy adult subjects were randomized to a treatment sequence involving the following products: a 0.454% stannous fluoride (1,100 ppm F) dentifrice (Procter & Gamble) and a control dentifrice containing 0.243% sodium fluoride (1,100 ppm F) and 0.3% triclosan (Colgate-Palmolive). Each study period consisted of 10 treatment days. Subjects wore an intra-oral appliance fitted with two polished human enamel samples for 6 hours per treatment day. While wearing the appliance, subjects swished with their assigned dentifrice slurry for 60 seconds twice daily and with 250 ml orange juice over a 10-minute period four times daily. After 10 days, enamel specimens were removed and measured for surface loss using contact profilometry.

Results: 36 subjects were enrolled and 33 completed the study (mean age = 41.8 years). The stannous fluoride dentifrice demonstrated 90.3% less enamel loss than the NaF/triclosan dentifrice (P < 0.001) at Day 10, with median enamel loss of 0.279 µm and 2.877 µm, respectively. Both products were well tolerated.

Clinical Significance: The stannous fluoride dentifrice provided significantly greater protection against dental erosion relative to the NaF/triclosan dentifrice.
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June 2019

Periodontal diagnosis in the context of the BSP implementation plan for the 2017 classification system of periodontal diseases and conditions: presentation of a patient with severe periodontitis following successful periodontal therapy and supportive periodontal treatment.

Br Dent J 2019 Mar;226(6):411-413

Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK.

Case report A case of a 59-year-old female patient who attended with a history of periodontitis, who had been successfully treated and maintained for several years, is described. Following a full periodontal assessment, the patient was diagnosed with 'generalised periodontitis; stage IV; grade C; currently stable'.Conclusion The present case report exemplifies the use of the 2017 classification system in a successfully treated and well-maintained patient whose treatment need is supportive periodontal treatment. It recognises the fact that, by staging and grading, the patient is a high-risk periodontitis patient due to historical disease experience, but also that following successful therapy and maintenance she is currently 'stable' with no need for active periodontal therapy.
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http://dx.doi.org/10.1038/s41415-019-0143-8DOI Listing
March 2019

Periodontal diagnosis in the context of the BSP implementation plan for the 2017 classification system of periodontal diseases and conditions: presentation of a patient with a history of periodontal treatment.

Br Dent J 2019 02;226(4):265-267

Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK.

This case report is the fourth in a series that illustrates the application of the BSP implementation plan for diagnosing periodontitis patients according to the 2017 classification. It demonstrates the diagnostic approach and disease classification for a previously treated patient who presented with a diagnosis of unstable generalised periodontitis; stage IV, grade C. We describe a case of a 49-year-old patient who attended with a history of periodontal treatment over several years. Following a full periodontal assessment, the patient was diagnosed with 'generalised periodontitis; stage IV, grade C; currently unstable'. This case report presents an example of how to classify and diagnose a patient using the 2017 classification system and highlights challenges with the application of the new classification in patients with a previous history of periodontal therapy.
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http://dx.doi.org/10.1038/s41415-019-0015-2DOI Listing
February 2019

Randomized in situ clinical trial evaluating erosion protection efficacy of a 0.454% stannous fluoride dentifrice.

Int J Dent Hyg 2019 Aug 19;17(3):261-267. Epub 2019 Feb 19.

Procter & Gamble, Mason Business Center, Mason, Ohio, USA.

Objectives: To assess the protective effects of a 0.454% stabilized stannous fluoride dentifrice and a marketed triclosan dentifrice against enamel erosion in a 10-day in situ model.

Methods: This was a double-blind, randomized, 2-treatment, 4-period, crossover in situ trial involving healthy adult participants. Participants were randomized to a treatment sequence involving the following products: a highly bioavailable 0.454% stannous fluoride dentifrice (Procter & Gamble) and a marketed dentifrice control containing 0.24% sodium fluoride and 0.3% triclosan (Colgate-Palmolive). Each study period took place over 10 days. Participants wore an intra-oral appliance retaining two polished human enamel samples for 6 hours per day. Two times per day they swished with the assigned dentifrice slurry and four times per day they swished with 250 mL of orange juice (25 mL per minute) over a 10-minute period. Contact profilometry measurements were made for each sample at baseline and day 10 to determine surface change.

Results: Thirty-six participants were enrolled and 33 completed the study (mean age = 40.5 years). The stannous fluoride dentifrice demonstrated 93.5% less enamel loss than the NaF/triclosan dentifrice (P < 0.001) at Day 10, with median enamel loss of 0.097 µm and 1.495 µm, respectively. Both products were well tolerated.

Conclusion: The stannous fluoride dentifrice demonstrated significantly greater erosion protection efficacy relative to the NaF/triclosan dentifrice in this randomized in situ clinical trial.
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http://dx.doi.org/10.1111/idh.12379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850309PMC
August 2019

The antibacterial efficacy of a foam mouthwash and its ability to remove biofilms.

BDJ Open 2018 27;4:17038. Epub 2018 Sep 27.

SPLAT Cosmetics LLC, Moscow, Russian Federation.

Objectives/aims: To evaluate the antimicrobial activity of a newly developed foam mouthwash containing a modified lactoperoxidase system in vitro.

Materials And Methods: Biofilms of five bacterial species were developed on hydrophobic and hydrophilic surfaces whilst salivary-based biofilm was grown on tooth enamel. Each surface was exposed to the foam mouthwash or saline in vitro. Optical density and scanning electron microscopy (SEM) was used to determine retention of the biofilm following 5 or 30 s exposure time.

Results: The foam mouthwash was active against biofilms formed by , , , and and eliminated significant amount of biofilm from each surface; immature 4 h biofilm was less resistant than 24 h biofilm. A 30 s rinse showed best performance, with removal of up to 66% of biofilm from the hydrophilic surface. SEM imaging confirmed oral biofilm removal from the enamel surface after a 5 s rinse with the foam mouthwash.

Discussion: Foam mouthwash demonstrated a significant impact on growing biofilm when compared against saline solution. Growing biofilms were more susceptible to the action of the foam mouthwash, which justifies after-meal use of the mouthwash when traditional dentifrices may not be accessible.

Conclusions: Foam mouthwash can be a convenient on-the-go format of oral care products that can be used after meals or when needed to reduce the risk of biofilm-associated oral conditions.
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http://dx.doi.org/10.1038/s41405-018-0005-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160478PMC
September 2018

Randomized clinical trial to determine if changes in dentin tubule occlusion visualized by SEM of replica impressions correlate with pain scores.

Am J Dent 2018 Aug;31(4):189-194

Restorative Dentistry (Periodontology), Clinical Trials Unit, Bristol Dental School, Bristol, UK.

Purpose: To quantify dentin tubule occlusion and correlate this with pain reduction in vivo.

Methods: This was a single-center, randomized two treatment, examiner-blind, parallel study. 20 participants with confirmed dentin hypersensitivity (DH) were evaluated by Schiff Air Blast, VAS Air Blast and replica impression of the tooth surface to visualize tubule occlusion at baseline and following 4-week twice daily use of either an occluding toothpaste (8% strontium acetate, 1,040 ppm fluoride) or a non-occluding toothpaste (1,450 ppm fluoride).

Results: Both treatments increased tubule occlusion significantly from baseline to 4 weeks (P= 0.01) with significant decreases in pain score only seen with the occluding toothpaste (Schiff, P= 0.01; VAS, P= 0.01). Schiff pain score after 4 weeks was markedly reduced following treatment with the occluding toothpaste as compared to the non-occluding toothpaste, (P= 0.05) with no significant differences between the pastes for occlusion score or patient reported VAS, although the scores favored the occluding toothpaste.

Clinical Significance: Occlusion scores as obtained by replica impression techniques with SEM imaging correlate significantly with DH pain scores confirming proof of concept. With further refinement, this technique could be used to accurately quantify tubule occlusion in vivo and the associated pain reduction achieved by occluding toothpastes.
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August 2018

Assessment of tubule occlusion properties of an experimental stannous fluoride toothpaste: A randomised clinical in situ study.

J Dent 2018 09 5;76:125-131. Epub 2018 Jul 5.

GSK Consumer Healthcare, Weybridge, Surrey, UK. Electronic address:

Objectives: To evaluate the ability of a modified in situ model to differentiate dentinal tubule occlusion properties of toothpaste formulations over 10 days of treatment.

Methods: This was a single-centre, three-treatment period, crossover, randomised, single-blind study with healthy participants wearing two lower oral appliances, each retaining four dentine samples, for 10 treatment days during each period of the study. Samples were power-brushed ex vivo twice on each treatment day with a Test toothpaste containing 0.454% stannous fluoride, a Control fluoride toothpaste containing 0.76% sodium monofluorophosphate, or mineral water. Dentine samples were subjected to in situ acid challenge (orange juice) on Days 9 and 10. Scanning electron microscopy images obtained at baseline and after 1, 4, 8 and 10 days of treatment were graded for degree of surface coverage by four calibrated examiners; the primary study endpoint was Day 8.

Results: After 4, but not 8, days' treatment, the degree of tubule occlusion increased in the dentine samples treated with the Test or Control toothpastes compared with the water-treated samples (p < 0.01 and p < 0.05, respectively). Following the acid challenge (Day 10), there was a statistically significantly greater degree of occlusion in the Test toothpaste-treated dentine samples compared with those treated with water (p < 0.01). No other comparisons were statistically significant. All study treatments were generally well-tolerated.

Conclusions: This modified in situ model was unable to demonstrate statistically significant between-treatment differences in dentinal tubule occlusion after 8 days. Conversely, there are recognised developments that could be made to better identify product differences. Clinicaltrials.gov: NCT02768194.

Clinical Significance: Dentine hypersensitivity can be managed through brushing with stannous fluoride toothpastes, which occlude patent dentine tubules. Clinical studies measure pain but in situ models are needed to demonstrate occlusion intra-orally. However, this study did not demonstrate superior occlusion with stannous toothpaste; further methodological development is required to investigate its mode of action.
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http://dx.doi.org/10.1016/j.jdent.2018.07.001DOI Listing
September 2018

Tooth loss is a complex measure of oral disease: Determinants and methodological considerations.

Community Dent Oral Epidemiol 2018 12 29;46(6):555-562. Epub 2018 Jun 29.

Department of Odontology, Umeå University, Umeå, Sweden.

Objectives: Counts of missing teeth or measures of incident tooth loss are gaining attention as a simple way to measure dental status in large population studies. We explore the meaning of these metrics and how missing teeth might influence other measures of dental status.

Methods: An observational study was performed in 2 contrasting adult populations. In total, 62 522 adult participants were available with clinically assessed caries and periodontal indices from the Swedish arm of the Gene-Lifestyle Interactions and Dental Endpoints Study (GLIDE) and the Korea National Health and Nutrition Examination Survey (KNHANES) in the Republic of Korea. Longitudinal measures of tooth loss were available for 28 244 participants in GLIDE with median follow-up of 10.6 years.

Results: In longitudinal analysis, hazard for tooth loss was associated with baseline dental status (previous tooth loss, periodontal status and caries status) and socio-demographic variables (age, smoking status and highest educational level). Analysis of cross-sectional data suggested that indices of caries exposure were not independent of periodontal status. The strength and direction of association varied between groups, even for measures specifically intended to avoid measuring tooth loss. Individuals with impaired periodontal health (community periodontal index [CPI] 3 or higher in any sextant) had higher standardized decayed and filled surfaces (DFS; number of DFS divided by total number of tooth surfaces) in GLIDE (incidence risk ratio [IRR] 1.05 [95% CI: 1.04, 1.07], but lower standardized DFS in KNHANES (IRR: 0.95 [0.92, 0.98]) than individuals with better periodontal health (CPI <3 in all sextants).

Conclusions: Incident tooth loss is a complex measure of dental disease, with multiple determinants. The relative importance of dental caries and periodontal disease as drivers of tooth loss differs between age groups. Measures of dental caries exposure are associated with periodontal status in the studied populations, and these associations can be population-specific. Consideration of the study-specific properties of these metrics may be required for valid inference in large population studies.
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http://dx.doi.org/10.1111/cdoe.12391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282797PMC
December 2018

Consortium-based genome-wide meta-analysis for childhood dental caries traits.

Hum Mol Genet 2018 09;27(17):3113-3127

Research Unit for Gynaecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark.

Prior studies suggest dental caries traits in children and adolescents are partially heritable, but there has been no large-scale consortium genome-wide association study (GWAS) to date. We therefore performed GWAS for caries in participants aged 2.5-18.0 years from nine contributing centres. Phenotype definitions were created for the presence or absence of treated or untreated caries, stratified by primary and permanent dentition. All studies tested for association between caries and genotype dosage and the results were combined using fixed-effects meta-analysis. Analysis included up to 19 003 individuals (7530 affected) for primary teeth and 13 353 individuals (5875 affected) for permanent teeth. Evidence for association with caries status was observed at rs1594318-C for primary teeth [intronic within ALLC, odds ratio (OR) 0.85, effect allele frequency (EAF) 0.60, P 4.13e-8] and rs7738851-A (intronic within NEDD9, OR 1.28, EAF 0.85, P 1.63e-8) for permanent teeth. Consortium-wide estimated heritability of caries was low [h2 of 1% (95% CI: 0%: 7%) and 6% (95% CI 0%: 13%) for primary and permanent dentitions, respectively] compared with corresponding within-study estimates [h2 of 28% (95% CI: 9%: 48%) and 17% (95% CI: 2%: 31%)] or previously published estimates. This study was designed to identify common genetic variants with modest effects which are consistent across different populations. We found few single variants associated with caries status under these assumptions. Phenotypic heterogeneity between cohorts and limited statistical power will have contributed; these findings could also reflect complexity not captured by our study design, such as genetic effects which are conditional on environmental exposure.
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http://dx.doi.org/10.1093/hmg/ddy237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097157PMC
September 2018

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

J Periodontol 2018 06;89 Suppl 1:S237-S248

Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.

Methods: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants.

Results: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.

Conclusion: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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http://dx.doi.org/10.1002/JPER.17-0733DOI Listing
June 2018

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

J Clin Periodontol 2018 06;45 Suppl 20:S219-S229

Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations.

Methods: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants.

Results: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues.

Conclusion: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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http://dx.doi.org/10.1111/jcpe.12951DOI Listing
June 2018

The Efficacy of Plasma Rich in Growth Factors for the Treatment of Alveolar Osteitis: A Randomized Controlled Trial.

J Oral Maxillofac Surg 2018 Jun 8;76(6):1150-1159. Epub 2018 Jan 8.

Professor and Honorary Consultant, Restorative Dentistry, University of Bristol, Oral and Dental Sciences, Bristol, UK. Electronic address:

Purpose: To investigate the efficacy of plasma rich in growth factors (PRGF; BTI Biotechnology Institute, San Antonio, Spain) for the treatment of alveolar osteitis compared with a positive control (Alvogyl; Septodont, Maidstone, Kent, UK).

Materials And Methods: This single-center, single-blinded, randomized, 2-treatment, parallel study was conducted in a UK dental hospital. All healthy adults who presented with alveolar osteitis after tooth extraction over a 3-month period were invited to participate. Each socket was randomized and treated with 1 of 2 treatment modalities, a test treatment (PRGF) or a positive control (Alvogyl). After treatment, patients were reviewed at 3 and 7 days by a second clinician blinded to the treatment given. Outcome measures included pain, exposed bone, inflammation, halitosis, dysgeusia, and quality-of-life assessment.

Results: Thirty-eight patients with data from 44 sockets (22 in the PRGF group and 22 in the Alvogyl group) were analyzed. The PRGF group showed significantly faster bone coverage and significantly decreased inflammation and halitosis (P < .05) compared with the control group receiving Alvogyl. There was no significant difference for pain, quality-of-life measures, or dysgeusia between groups.

Conclusion: PRGF predictably treated alveolar osteitis after tooth extraction compared with the conventional standard treatment of Alvogyl, which has been used for many years. PRGF could be considered an alternative treatment for alveolar osteitis and indeed appears to have considerable advantages over Alvogyl.
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http://dx.doi.org/10.1016/j.joms.2017.12.025DOI Listing
June 2018

An interproximal model to determine the erosion-protective effect of calcium silicate, sodium phosphate, fluoride formulations.

Dent Mater 2018 02 24;34(2):355-362. Epub 2017 Nov 24.

Clinical Trials Group, School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK. Electronic address:

Objectives: Previous work has shown the effectiveness of a newly developed interproximal model to differentiate between the amount of remineralization caused by toothpastes used with or without a dual-phase gel treatment system containing calcium silicate, sodium phosphate salts and fluoride to repair acid-softened enamel. The aim of this study was to utilize the same interproximal model to identify how effective calcium silicate phosphate toothpastes are at reducing surface softening in the early stages of erosion. The model was also used to identify the effect of increasing the frequency of acid exposure on the reduction in surface hardness.

Methods: Human enamel specimens were prepared and mounted in an interproximal face-to-face arrangement and exposed to a cycling regime of whole human saliva, treatment, artificial saliva and 1% citric acid pH 3.75. Specimens were measured by surface microhardness at baseline and after three and seven days. The frequency of acid exposure was increased from 2 to 4 cycles a day for the second part of the study.

Results: The results showed that specimens treated with the calcium silicate phosphate toothpastes softened less than those treated with control fluoridated or non-fluoride toothpastes at each time point and following an increase in the frequency of acid exposure.

Significance: This work has demonstrated how an interproximal model can also be successfully used to determine differences in the erosion protection of various treatments as well as determining how they perform when the frequency of acid exposure is increased.
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http://dx.doi.org/10.1016/j.dental.2017.11.017DOI Listing
February 2018

Guest editorial.

Authors:
Nicola X West

J Dent 2017 12 8;67S:S1-S2. Epub 2017 Sep 8.

Periodontology, Clinical Trials Unit, Bristol Dental School, Lower Maudlin Street, Bristol, BS1 2LY, United Kingdom. Electronic address:

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http://dx.doi.org/10.1016/j.jdent.2017.09.002DOI Listing
December 2017

16S rRNA Next Generation Sequencing Analysis Shows Bacteria in Alzheimer's Post-Mortem Brain.

Front Aging Neurosci 2017 20;9:195. Epub 2017 Jun 20.

School of Clinical Sciences, Faculty of Health Sciences, University of BristolBristol, United Kingdom.

The neurological deterioration associated with Alzheimer's disease (AD), involving accumulation of amyloid-beta peptides and neurofibrillary tangles, is associated with evident neuroinflammation. This is now seen to be a significant contributor to pathology. Recently the tenet of the privileged status of the brain, regarding microbial compromise, has been questioned, particularly in terms of neurodegenerative diseases. It is now being considered that microbiological incursion into the central nervous system could be either an initiator or significant contributor to these. This is a novel study using 16S ribosomal gene-specific Next generation sequencing (NGS) of extracted brain tissue. A comparison was made of the bacterial species content of both frozen and formaldehyde fixed sections of a small cohort of Alzheimer-affected cases with those of cognitively unimpaired (normal). Our findings suggest an increase in bacterial populations in Alzheimer brain tissue compared with normal.
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http://dx.doi.org/10.3389/fnagi.2017.00195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476743PMC
June 2017

Randomised clinical trial to evaluate changes in dentine tubule occlusion following 4 weeks use of an occluding toothpaste.

Clin Oral Investig 2018 Jan 1;22(1):225-233. Epub 2017 Apr 1.

Periodontology, Clinical Trials Unit, Bristol Dental School, Lower Maudlin Street, Bristol, BS1 2LY, UK.

Objectives: The objective of this study is to determine whether a silicone impression material could precisely replicate dentine tubule changes following 4 weeks toothbrushing with occluding or non-occluding toothpaste and whether changes reflected hypersensitivity clinical assessment.

Materials And Methods: This was a single site, examiner blind, parallel, two treatment arm, randomised clinical trial. Participants were healthy, ≥18, with ≥1 sensitive tooth with exposed dentine, Schiff sensitivity score ≥2, and patent tubules with dentine occlusion score 4-5 as determined by scanning electron microscopy of replica impressions. Nine participants received Sensodyne® Rapid Relief (occluding toothpaste) and 10 Crest® Decay Prevention (non-occluding toothpaste), and were re-evaluated for sensitivity and occlusion score after two timed minutes and 4 weeks twice-daily home brushing.

Results: Occlusion scores did not correlate significantly with pain scores, but correlations were positive and impressions showed characteristic dentine tubule patency and occlusion. After 4 weeks, thermal VAS was significantly lower than baseline for the non-occluding toothpaste; all other pain scores were significantly lower for both treatments. Dentine occlusion scores also decreased after 4 weeks of either treatment, but did not achieve significance (p = 0.0625).

Conclusions: Both toothpastes reduced clinical sensitivity and increased tubule occlusion. It is hypothesised that during impression, taking some material may have sheared off and occluded tubules resulting in false positives.

Clinical Relevance: This study has demonstrated that a silicone impression material can accurately replicate the dentine surface to demonstrate dentine tubular occlusion and patency; however, although the association between occlusion and pain score was positive, this technique needs to be refined before use in future studies.
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http://dx.doi.org/10.1007/s00784-017-2103-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748408PMC
January 2018

Establishing the Effect of Brushing and a Day's Diet on Tooth Tissue Loss in Vitro.

Dent J (Basel) 2016 Aug 9;4(3). Epub 2016 Aug 9.

Clinical Trials Unit, School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, UK.

To develop an in vitro model to mimic the effects of meals equivalent to a day's diet on tooth tissue loss (TTL). To identify how diet effects tooth wear and to test the efficacy of dental products designed to reduce tooth wear in a more realistic environment. A typical Friday diet was devised comprising: Breakfast then brushing, lunch, dinner then brushing. Groups of enamel samples were exposed to one meal, or all three in series, a control group was exposed to water and brushed. The daily cycle was repeated to represent two days' consumption; TTL was quantified by non-contact profilometry. This pilot study highlighted adaptions that could be made to the model such as human enamel and saliva to further replicate natural eating habits. The sum of the TTL measured after Breakfast, lunch and dinner (bovine enamel specimens exposed to single meals) was less than that exhibited by the group of samples exposed to the series of meals but this difference was not significant ( = 0.09).In the absence and presence of brushing, TTL caused by breakfast and dinner was similar, but significantly greater than that caused by lunch ( < 0.05). While brushing increased TTL, this increase was not significant. It is possible to model a daily diet in vitro, and the data obtained confirms that the combination of food and drink affects the degree of TTL. This supports the further development of an in vitro model that includes alternative foodstuffs. This would aid understanding of the effects different diets have on TTL and could test new products designed to prevent TTL.
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http://dx.doi.org/10.3390/dj4030025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806935PMC
August 2016

In vivo model for microbial invasion of tooth root dentinal tubules.

J Appl Oral Sci 2016 Apr;24(2):126-35

Department of Oral and Dental Sciences, University of Bristol, Bristol, United Kingdom.

Objective Bacterial penetration of dentinal tubules via exposed dentine can lead to root caries and promote infections of the pulp and root canal system. The aim of this work was to develop a new experimental model for studying bacterial invasion of dentinal tubules within the human oral cavity. Material and Methods Sections of human root dentine were mounted into lower oral appliances that were worn by four human subjects for 15 d. Roots were then fixed, sectioned, stained and examined microscopically for evidence of bacterial invasion. Levels of invasion were expressed as Tubule Invasion Factor (TIF). DNA was extracted from root samples, subjected to polymerase chain reaction amplification of 16S rRNA genes, and invading bacteria were identified by comparison of sequences with GenBank database. Results All root dentine samples with patent tubules showed evidence of bacterial cell invasion (TIF value range from 5.7 to 9.0) to depths of 200 mm or more. A spectrum of Gram-positive and Gram-negative cell morphotypes were visualized, and molecular typing identified species of Granulicatella, Streptococcus, Klebsiella, Enterobacter, Acinetobacter, and Pseudomonas as dentinal tubule residents. Conclusion A novel in vivo model is described, which provides for human root dentine to be efficiently infected by oral microorganisms. A range of bacteria were able to initially invade dentinal tubules within exposed dentine. The model will be useful for testing the effectiveness of antiseptics, irrigants, and potential tubule occluding agents in preventing bacterial invasion of dentine.
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http://dx.doi.org/10.1590/1678-775720150448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836919PMC
April 2016